Each federal, provincial, and territorial (FPT) public drug plan provides access to prescription medications for specific populations. FPTs rely on guidance from health technology assessment agencies such as CADTH; however, reimbursement decisions for individual medications follow different local processes. This Environmental Scan sought to compare these reimbursement decision-making processes (e.g., drug review processes, decision-making principles and/or frameworks, decision-making committee structures).
Decision-making processes were evaluated for all provinces as well as for Yukon and the Non-Insured Health Benefits (NIHB) program. Decision-making processes were stratified for oncology versus non-oncology medications as well as for CADTH review–eligible versus CADTH review–ineligible products.
There were 2 models of decision-making processes with a geographic divide: local expert committees reviewing all new drug submissions (Western model) versus reviewing only drug submissions out of scope for CADTH (Eastern model). If decision-making processes were to be harmonized across FPTs, there would need to be a balance between local autonomy versus centralization.